Der Schmerz

, Volume 24, Issue 6, pp 633–641 | Cite as

Tumorspezifische Therapien und ihr Einsatz in der Palliativmedizin

CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

In der modernen Onkologie vollziehen sich zurzeit weitreichende Veränderungen, die sich einerseits in konzeptuellen Entwicklungen und erweiterten Möglichkeiten, Tumortherapien nach individuellem Risiko und tumorbiologischen Aspekten zu individualisieren, andererseits in einer Vielzahl neuer tumorspezifischer Substanzen widerspiegeln. Diese Entwicklungen haben auch Auswirkungen auf die Behandlung von Patienten mit inkurablen, fortgeschrittenen Tumorerkrankungen, bei denen Schmerztherapie und Symptomkontrolle, Lebensqualität und andere palliativmedizinische Therapieziele im Vordergrund stehen. Für die Tumorschmerztherapie und die Palliativmedizin können Kenntnisse moderner onkologischer Therapien hilfreich sein, da diese das Potenzial haben, die mit der Grunderkrankung einhergehende Symptomlast zu reduzieren, und – nach sorgfältiger, interdisziplinärer Abwägung von deren möglichen Risiken, Nebenwirkungen und erhofftem Nutzen – in palliativmedizinische Behandlungskonzepte integriert werden können.

Schlüsselwörter

Chemotherapie Targeted therapies Therapieziel Mutationsanalysen Palliativmedizin 

Implications of modern anticancer therapies for palliative care concepts

Abstract

In modern oncology, paradigmatic developments can be witnessed with respect to conceptual strategies and to individualized diagnostics and treatment approaches, but foremost with respect to the amazing number of new anticancer substances available. These developments will certainly influence the care of patients suffering from incurable and advanced cancer, where pain therapy and symptom control, quality of life and other intentions of palliative care are urgent. For cancer pain therapy and palliative care, knowledge about these developments may be helpful not only with respect to interdisciplinary decision making, but also for thoroughly balancing risks, side effects and benefits of oncological interventions that have the potential to stabilize disease progression and thereby reduce symptom intensity.

Keywords

Chemotherapy Targeted therapies Therapeutic intention Mutational analysis Palliative care 

Literatur

  1. 1.
    World Health Organisation (WHO) (1996) Cancer pain relief, with a guide to opioid availability, 2. Aufl. WHO, GenevaGoogle Scholar
  2. 2.
    Sobrero A, Andretta V (2008) Small molecule inhibitors of tyrosine kinase: waiting for the good news in colorectal cancer. Onkologie 31:224–225CrossRefPubMedGoogle Scholar
  3. 3.
    Medicines in development for cancer. http://www.phrma.org/medicines_in_development_for_cancer/Google Scholar
  4. 4.
    Colomer R, Alba E, Gonzales-Martin A et al (2010) Treatment of cancer with oral drugs: a position statement by the Spanish Society of Medical Oncology (SEOM). Ann Oncol 21:195–198CrossRefPubMedGoogle Scholar
  5. 5.
    Winer E, Gralow J, Diller L et al (2009) Clinical advances 2008: major research advances in cancer treatment, prevention and screening – a report from the American Society of Medical Oncology. J Clin Oncol 27:812–826CrossRefPubMedGoogle Scholar
  6. 6.
    Bruzzi P, DelMastro L, Sormani MP et al (2005) Objective response to chemotherapy as a potential surrogate end point of survival in metastatic breast cancer patients. J Clin Oncol 23:5117–5125CrossRefPubMedGoogle Scholar
  7. 7.
    Buyse M, Thirion P, Carlson RW et al (2000) Relation between tumor response to first-line chemotherapy and survival in advanced colorectal cancer: meta-analysis. Meta-Analysis Group in Cancer. Lancet 356:373–378CrossRefPubMedGoogle Scholar
  8. 8.
    Hotta K, Kiura K, Fujiwara Y et al (2009) Association between incremental gains in the objective response rate and serviva improvement in phase III trials of first-line chemotherapy for extensive disease small-cell lung cancer. Ann Oncol 20:829–834CrossRefPubMedGoogle Scholar
  9. 9.
    Ferraldeschi R, Lorigan P (2009) Extensive-disease small-cell lung cancer – moving beyond response rate? Ann Oncol 20:801–802CrossRefPubMedGoogle Scholar
  10. 10.
    Geyer CE, Forster J, Lindquist D et al (2006) Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med 335(26):2733–2743CrossRefGoogle Scholar
  11. 11.
    Braun S, Marth C (2004) Circulating tumor cells in metastatic breast cancer – toward individualized treatment? N Engl J Med 351:824–825CrossRefPubMedGoogle Scholar
  12. 12.
    Dahut WL, Scripture C, Posadas E et al (2008) A phase II clinical trial of sorafenib in androgen-independent prostate cancer. Clin Cancer Res 14(1):209–214CrossRefPubMedGoogle Scholar
  13. 13.
    Armstrong AJ, Garrett-Mayer E, Ou Yang YC et al (2007) Prostate-specific antigen and pain surrogacy analysis in metastatic hormone-refractory prostate cancer. J Clin Oncol 25:3965–3970CrossRefPubMedGoogle Scholar
  14. 14.
    Bördlein-Wahl I, Hilpert F, Kohlmann T (2009) Therapiebeurteilung aus Patientensicht – patient reported outcomes. Onkologie 32(Suppl 1):18–20CrossRefPubMedGoogle Scholar
  15. 15.
    Burris H, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15(6):2403–2413PubMedGoogle Scholar
  16. 16.
    Shepherd FA, Rodrigues Pereira J, Ciuleanu T et al (2005) Erlotinib in previously treated non-small cell lung cancer. N Engl J Med 353:123–132CrossRefPubMedGoogle Scholar
  17. 17.
    Ohorodynk P, Eisenhauer EA, Booth CM (2009) Clinical benefit in oncology trials: is this a patient-centered or tumor-centered end-point? Eur J Cancer 45:2249–2252CrossRefGoogle Scholar
  18. 18.
    Kim ES, Hirsh V, Mok T et al (2008) Gefitinib versus docetaxel in previously treated non-small cell lung cancer (INTEREST): a randomized phase III trial. Lancet 372:1809–1818CrossRefPubMedGoogle Scholar
  19. 19.
    Tassinari D, Drudi F, Lazzari-Agli L et al (2010) Second-line treatments of advanced non-small cell lung cancer: new evidence for clinical practice. Ann Oncol 21:428–429CrossRefPubMedGoogle Scholar
  20. 20.
    Bezjak A, Tu D, Seymour L et al (2006) Symptom improvement in lung cancer patients treated with erlotinib: quality of life analysis of the National Cancer Institute of Canada clinical trials group study BR.21. J Clin Oncol 24(24):3831–3837CrossRefPubMedGoogle Scholar
  21. 21.
    Berry DL, Moinpour CM, Jiang CS et al (2006) Quality of life and pain in advanced stage prostate cancer: results of a Southwest Oncology Group randomized trial comparing docetaxel and estramustine to mitoxantrone and prednisone. J Clin Oncol 24(18):2828–2835CrossRefPubMedGoogle Scholar
  22. 22.
    Caraceni A, DeDonno F (1998) Analgesic effects of chemotherapy? J Clin Oncol 16(2):803PubMedGoogle Scholar
  23. 23.
    Siena S, Crinò L, Danova M et al (2010) Dose-dense temozolomide regimen for the treatment of brain metastases from melanoma, breast cancer, or lung cancer not amenable to surgery or radiosurgery: a multicenter phase II study. Ann Oncol 21:655–661CrossRefPubMedGoogle Scholar
  24. 24.
    Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: Revised RECIST guidelines (version 1.1.). Eur J Cancer 45:228–247. http://www.eortc.be/recist/documents/RECISTGuidelines.pdfGoogle Scholar
  25. 25.
    Benjamin RS, Choi H, Macapinlac HA et al (2007) We should desist using RECIST, at least in GIST. J Clin Oncol 25:1760–1764CrossRefPubMedGoogle Scholar
  26. 26.
    Choi H, Charnsangavey C, Faria SC et al (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of a new computed tomography response criteria. J Clin Oncol 25(13):1753–1759CrossRefPubMedGoogle Scholar
  27. 27.
    Junker A (2009) Personalisierte Krebsmedizin – immer erfolgreicher umsetzbar. Dtsch Ärztebl 30:1285–1286Google Scholar
  28. 28.
    Sarmiento R, Gasparini G (2008) Antiangiogenic metronomic chemotherapy. Onkologie 31:161–162CrossRefPubMedGoogle Scholar
  29. 29.
    Görn M, Habermann C, Anige M et al (2008) A pilot study of docetaxel and trofosfamide as second-line „metronomic“ chemotherapy in the treatment of metastatic non-small cell lung cancer. Onkologie 31:185–189PubMedGoogle Scholar
  30. 30.
    Rosell R, Moran T, Queralt C et al (2009) Screening for epidermal growth factor receptor mutations in lung cancer. N Engl J Med 361:958–967CrossRefPubMedGoogle Scholar
  31. 31.
    Lim WT, McLeod HL (2004) Should screening for DPD deficiency be mandatory before 5-FU exposure? Onkologie 27:531CrossRefPubMedGoogle Scholar
  32. 32.
    Helbekkmo N, Aasebo U, Sundstrom SH et al (2008) Treatment outcome in performance status 2 advanced NSCLC patients administered platinum-based combination chemotherapy. Lung Cancer 62:253–260CrossRefPubMedGoogle Scholar
  33. 33.
    Sandler A, Gray R, Perry MC et al (2006) Paclitaxel – carboplatin alone or with bevacizumab for non-small cell lung cancer. N Engl J Med 355:2542–2550CrossRefPubMedGoogle Scholar
  34. 34.
    Earle CC, Landrum MB et al (2008) Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 26(23):3860–3866CrossRefPubMedGoogle Scholar
  35. 35.
    Bauer AW (2003) Futility-Debatte in der Onkologie – ein ethisches und rechtliches Problem. Onkologe 9:1325–1334CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Abteilung PalliativmedizinUniversitätsmedizin GöttingenGöttingenDeutschland

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